Too Old For a Mammogram?

When to stop screening? My 85 year old patient was ‘disappointed’ that I turned down her request for a mammogram requisition slip. Her mammogram was a birthday ritual and had been for decades. She had no unusual risk factors for breast cancer and performed breast-self examinations monthly. While a matter of debate, finding breast cancer at age 85 may not help my patient survive longer, but it may cause medical problems, diminish her quality of life and cause unnecessary distress.

There is no doubt that screening mammograms will pick cancers at an earlier stage. The question of what to do if a cancer is found will be based on type of cancer, if there are other medical conditions, expected life expectancy and the wishes of the patient. Most of the studies that looked at women who had screening mammography after age 80 have found that those women tended to be white, married, and have higher education and income levels. They also were in better health with fewer other conditions such as heart disease or diabetes. The data are not clear if early detection of breast cancer in elderly women increase survival. For women with other medical problems (lung disease, peripheral vascular disease, heart disease, diabetes, rheumatologic disease), mammograms did not increase survival.

This discussion is about screening mammograms only. Any breast mass or breast change requires an evaluation – which could include mammogram, ultrasound or MRI.

I read an excellent guideline – women should have a yearly screening mammogram until they believe that they don’t have ten good years left.